RT Journal
A1 Moore C
T1 NEed for a patient advocate
JF JAMA
JO JAMA
YR 1989
FD July 14
VO 262
IS 2
SP 259
OP 260
DO 10.1001/jama.1989.03430020101038
UL http://dx.doi.org/10.1001/jama.1989.03430020101038
AB GOVERNMENT and the insurance industry have intruded in recent years into the delicate, crucial relationship between physicians and patients. The primary physician's ability to play an unbiased role in the decisions about optimum care and a patient's faith in one physician's capacity to manage important health matters are disappearing.1 Experts foresee no relief from this medical care muddle (New York Times. May 2, 1988:26).2-4 When major disease strikes today, care is revealed to be patterned by quasi-medical and nonmedical forces. Optimum care becomes rationed by the size and wealth of each medical care complex.5 Routine care often follows this dictum: treat at local facilities until things go badly, then refer (this can waste money and often harms patients). The patient is caught in the middle.Primary physicians working in this new milieu struggle to sustain complete commitment to patient welfare.6 To survive, many primary physicians today